| NPI | 1770966897 |
|---|---|
| Other Name | NA NA |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD469807) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: PA MD469807) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2022-06-23 |